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What are "dermal fillers"?

Dermal Fillers

Steve Fallek (Plastic Surgeon and Medical Director, Face Focus Medical Spa) gives expert video advice on: How many different types of dermal fillers are available?; How do I find a qualified medical spa that performs dermal filler treatments?; Can I wear makeup after receiving any dermal filler treatment? and more...

What are "dermal fillers"?

Dermal fillers are part of a category of what is called "injectables". And what dermal fillers do is they fill up the dermis, which is the main layer of the skin, which helps prevent wrinkles. Examples of dermal fillers are Restylane, Juvederm, Prolane, and even something such as fat.

How many different types of dermal fillers are available?

If you include Europe and South America, there's probably over 25, maybe 35 different types of dermal fillers. Not every one of these dermal fillers is available within this country. The FDA has been very good in terms of making sure that dermal fillers are safe and effective before they get approved in this country. Many times patients will come with dermal fillers from Canada or from Europe and ask doctors to inject it into them, knowing that these dermal fillers don't have FDA approval. I don't think this is necessarily a good idea. The dermal fillers may be safe and effective, but if the FDA hasn't approved them, when in fact there are many injectable dermal fillers that are already FDA approved, I think you're better off just using the dermal fillers we know are safe and effective.

Are there any health benefits to dermal fillers?

There are no health benefits to dermal fillers besides making you feel good about yourself, and making you look younger and more youthful. It's not going to do anything besides that.

What causes wrinkles?

There are really two types of wrinkles. There's what's called static wrinkles and dynamic wrinkles. When we smile we have dynamic wrinkles, and when our face is at rest we have static wrinkles. As we get older and our dermis becomes thinner, and our muscles become thinner, and the skin overlying those areas is not as attached as before, that's when we start to get static wrinkles, which are really most of what patients' concerns are.

What is hyaluronic acid?

Hyaluronic acid is, in the fancy term, a mucopolysaccharide, which means it's a complex sugar that's part of who we are. It's involved in almost every part of our body, and because it's a naturally occurring substance within our body, it is safe, effective, and we don't have to worry about there being an allergy to it.

Are there differences among the hyaluronic acids?

When we talk about hyaluronic acids, whether or not we're talking about Juvederm, Restylane, Hylaform, or Kaptik, all of them are essentially the same product. They're all hyaluronic acids which are naturally occurring substances in our body. Manufacturers all claim that there are small differences. For the most part, all of them work the same; they're all safe and effective. Whether or not they last a bit longer, we're talking about a one or two month difference. So, for the most part, the hyaluronic acid and dermafillers are pretty much the same thing.

What is collagen?

For a long time collagen was considered the gold standard for dermal fillers because it worked and it was effective. The problem with collagen is, because it was made from bovine collagen or non-human (actually cow) collagen, it required pre-testing. That means that patients would have to come in, get a small injection of the collagen usually in the arm area, and then patients would come back two weeks later to see whether or not they had a reaction to the collagen. Now for the patients that had collagen it works great and it really is effective, but most patients didn't want to wait two weeks before having collagen injections. What happened was that new dermal fillers, such as Restylane, Juvederm, Perlane came out. The hyaluronic acid fillers came out. There was no pre-testing that was required. This made our job much easier and patients could have a treatment at that exact time. Therefore collagen, although safe, effective, and having been in use for many, many years has really started to have been phased out.

Can I receive a dermal filler injection if I am on medication?

The only medications that I, as an injector, and as a plastic surgeon are concerned about with a dermal filler are any of the anti-coagulants such as aspirin, coumadin, any blood thinner. The other area where I always ask my patients is whether or not they are taking herbal medications because unknown to patients many times these herbs do have blood thinning properties. which could affect the dermal filler injection

Will I need anaesthesia for dermal filler treatments?

Your doctor and you will decide whether or not you need an anaesthetic agent. The two types of anaesthetic agents are EMLA cream which is a topical anaesthetic and usually applied about half an hour before the procedure. The other type of anaesthesia is local anaesthesia which includes an injection into the areas to be treated. Many doctors don't necessarily like to do the local injections because that adds volume to the area and that may mask our treatment.

Who can perform dermal filler treatments?

This is a very grey area. Almost any doctor can perform dermal filler injections, and any nurse, anaesthetist, nurse practitioner, or physician's assistant in a doctor's office can do these injections. I'm always amazed that there are doctors in this country that have very fancy names and claim to do a lot of Botox or dermal filler injections, yet you go to their office and they're not even the ones doing the injections. If you're paying a lot of money for a dermal filler treatment, I think it's a good idea that the doctor does the actual injections.

Are the costs of dermal fillers covered by insurance?

No; insurance will not cover any dermal filler treatments. The cost of dermal fillers really runs the gamut, depending on what dermal filler you have and where you live. Prices can range anywhere from $5 to $15, and again a lot depends on what part of the country you're in, which dermal filler you're using, and who your doctor is.

Who can get dermal fillers?

There really are very few people that can't get dermal fillers. For anybody that has either static or dynamic wrinkles, and is concerned about the way that their face looks, dermal fillers are really a good treatment option. What I like about dermal fillers is many times patients have concerns about facial aging and by using dermal fillers you may be able to push back a facelift, or an eyelid lift, or any other procedure for a couple of years. So, there are really very few patients that can't have dermal fillers.

Who should not get dermal fillers?

I think dermal fillers are very safe, very effective and good for almost all patients. The only patients that shouldn't get dermal fillers are patients that are pregnant, teenagers or children should not get dermal fillers unless there's a medical condition. And certainly anybody taking blood thinner or anticoagulant or herbal medications that may cause them to bleed should discontinue those medications if medically safe before having a dermal filler injection.

Can dermal fillers prevent aging?

I get asked a lot by young people whether or not they need Botox or dermal fillers, and when you examine a patient and there are no wrinkles and there are no lines, having a Botox injection or having a dermal filler is really not going to help them, and not going to prevent those wrinkles from forming.

Do I need to take time off after receiving a dermal filler treatment?

The recovery time after dermal filler is rather minimal. We do ask you to take makeup off before you have a dermal filler and the downtime is usually applying makeup after the dermal filler. So, the downtime is almost none and you can go back to work and on with your day rather quickly.

Can I wear makeup after receiving any dermal filler treatment?

I think using make-up after dermal filler is an excellent idea. There can be a small amount of bruising and swelling that's involved in the dermal filler injection, so make-up can be applied after dermal filler to camouflage those areas. As long as you don't vigorously apply it, then there's no reason that you can't put make-up on after the procedure.

What should I do if I experience any problems after receiving a dermal filler treatment?

One of the reasons that you should see a plastic surgeon or a doctor who is board certified is, God forbid, if there is a problem after a dermal filler treatment. You should call that doctor right away, and the doctor should see you if you have any questions or any concerns regarding the dermal filler injection.

Will weather affect any of my dermal filler injections?

I've researched this question and I have found nothing to tell me that weather has any effect any of the dermal fillers.